Delayed presentation and treatment of popliteal artery embolism

Popliteal artery embolism (obstruction by a blood clot of the leg artery below the knee which supplies blood to the lower leg and foot) is associated with acute onset of symptoms and a high risk of loss of the leg. A review is presented of 10 years of treatment of 58 patients with 60 popliteal artery embolisms; two distinct patterns of onset are identified. Forty-one patients (68 percent) had acute onset; symptoms were present for less than a week, the median duration of symptoms was 12 hours. Eighty percent of these patients had immediate threat to their leg (loss of sensation or movement or evidence of muscle compromise) and 90 percent were treated with embolectomy (surgical removal of the embolism) alone. There were 19 patients (32 percent) who had delayed symptoms; median symptom duration was 30 days, with a range of 7 to 120 days. Typically, these patients with delayed onset had a history of sudden onset of claudication (weakness and cramps of the legs) and leg pain at rest. Two thirds of the 19 patients underwent embolectomy alone, whereas four patients required bypass graft. Results of treatment in the delayed-symptom group revealed no deaths and 95 percent success (salvage of the leg); the acute-symptom group had 10 percent mortality and 90 percent success. These results indicate an improvement in outcome in surgical treatment of popliteal artery embolism. As many as one third of the patients may have delayed presentation with chronic symptoms; most of these patients can be successfully treated with embolectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)